The skin is the largest organ of the body. It is important to protect it and keep it healthy. Pressure injuries, sometimes known as pressure ulcers or bed sores, can be caused by pressure, friction and/or shear of the skin. A person is more at risk if they are sick, frail, cannot move easily or have poor food and fluid intake.
For various reasons, people may end up sitting or lying in the same position for long periods of time. This puts the skin under different types of pressure. It is important to understand how to relieve this. Preventing Pressure Injuries is an excellent video produced by the Canterbury District Health Board that provides easy-to-follow guidance on avoiding the problem. It uses the acronym SSKIN to provide a framework for prevention. Here is a summary of what the video says.
Surface and Devices
When a person is sitting up in bed there will be high pressure on their tailbone. If they are sitting higher than 30 degrees, slippage will create shear forces. This means the skin and underlying bone will move in different directions, causing damage to the skin and tissue. If possible, keep the person’s backrest to less than 30 degrees. Some beds and mattresses have a helpful angle indicator.
Heels and ankles are where pressure injuries are most common, hence the importance of preventing a person slipping in bed – this can cause shearing of the skin. When caring for tall people, watch where their feet are as they may be touching the end of the bed, causing pressure.
Pillows, cushions and mattresses can significantly reduce pressure injuries. There are several options and each person’s needs differ, so selecting a mattress should be based on a full clinical assessment. This should include mobility status, the person’s ability to tolerate products and whether they can use them.
Regular repositioning is essential. If the skin is marking, even with regular turning, then specialised equipment may be available to help. Talk to your GP about this. Medical devices such as catheters, nasal prongs, splints and casts can cause pressure, so careful positioning is essential.
This should be done regularly so take any opportunity. A skin inspection will identify any signs of pressure damage such as discoloration, change in temperature, swelling, bogginess or skin loss. It is also important to identify any areas of pain or discomfort.
No equipment will reduce the need for people to move. Moving the person when they are uncomfortable or have loss of feeling is important. Assess the individual’s skin tolerance for a positioning schedule. A simple change in position is all that is needed to prevent pressure injuries.
Having a Mobility Plan helps ensure a person’s needs are met. The plan should include a repositioning or walking schedule, aids and the people required. It is great if it is by the bedside. Get the person involved.
Incontinence and Moisture
If the person has an incontinence product, such as a pad, ensure this is changed, if full, before a position change as they increase the risk of pressure and skin damage. A person who experiences incontinence is 40 percent more likely to sustain a pressure injury. Ensure incontinence products are the correct type and the right size and shape. You should question if they are even necessary.
Nutrition and Hydration
Nutrition plays a major part in maintaining optimum skin health. Screening for malnutrition, regular weight checks and observing the kind and quantity of food and drink consumed are vital for preventing pressure injuries. Research suggests that in the over 65 age group as many as 40 percent are malnourished. Being overweight also puts people at risk. If you are concerned about nutrition, follow up with your GP.